| NPI | 1649255613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 72351) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 72351) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2007-07-08 |